| NPI | 1619905205 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID A. WALLACE President 954-590-3770 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: FL PH22054) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2020-08-22 |